Preventing suicides must remain a priority

Editor—Davies et al are sceptical about the intention to reduce suicide set out in the national service framework on mental health, mainly because they regard suicide as rare.¹ In fact, there are around 5000 suicides a year in England. This is more than the number of deaths in motor vehicle crashes and more than 10 times the number of deaths from the sudden infant death syndrome (cot deaths). Should we therefore give up on road safety? Should we stop advising parents about smoking or sleeping position? The number of cases may make it difficult for research to use suicide as an outcome, but that is a different issue.

Davies et al quote a finding from the national confidential inquiry into suicide and homicide by people with mental illness (one of my own projects). This says that few people under mental health care who commit suicide have been regarded by clinicians as being at high immediate risk in the days or weeks before death. They argue that improving risk assessment by staff would not therefore be worthwhile. This is not what the finding means.

The inquiry figures show that to prevent suicide in clinical practice we need to strengthen services as a whole rather than focus only on the care of people known to be at high risk. This is particularly true in areas where services are weak—for example, in dealing with non-compliance or loss of contact, or in providing early follow up after discharge from hospital.

Suicide is the commonest cause of death in young men in England and the main cause of premature death in psychiatric patients. To reduce suicide we need a broadly based strategy, incorporating public health and clinical interventions, targeting key groups such as young men and restricting access to common methods of suicide such as overdose. A national suicide prevention strategy is now in preparation.